To evaluate which are the most effective procedures to maintain and recover soft tissue health around dental implants.
The Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE and EMBASE were searched with no language restriction up to June 2007. Handsearching included several dental journals, the bibliographies of the randomised controlled trials (RCTs) and relevant review articles.
RCTs comparing agents or interventions for maintaining or recovering peri-implant healthy tissues were eligible. Outcome measures were: implant failure, radiographic marginal bone level changes, changes in probing 'attachment' level, changes in probing pocket depth, marginal bleeding, plaque, side effects, ease of maintenance, patient satisfaction, cost, and treatment time. Screening of eligible studies, quality assessment and data extraction were conducted in duplicate. Authors were contacted for missing information. Results were expressed as random effect models using standardised mean differences for continuous data and relative risks for dichotomous data with 95% confidence intervals.
Eighteen RCTs were identified. Nine (238 patients) were included. Follow-ups ranged between 6 weeks and 1 year. No meta-analysis could be made since all trials tested different interventions. Listerine mouthwash showed a reduction of 54% in plaque and 34% in marginal bleeding compared with a placebo after 3 months.
There was little reliable evidence for which are the most effective interventions for maintaining healthy peri-implant soft tissues. However, it should not be interpreted that current maintenance regimens are ineffective. There is a definite need for trials powered to find possible differences, using primary outcome measures and with much longer follow-up.
"Dental implant research has focused on the interface between dental implants (titanium) and the surrounding soft tissues (Cairo et al., 2008; Grusovin et al., 2008). In vivo and in vitro investigations can help to understand the structural, functional and molecular properties of the biological seal and defense mechanisms acting at the interface between the peri-implant mucosa and dental implants (Baschong et al., 2001; Chai et al., 2010). "
[Show abstract][Hide abstract] ABSTRACT: Missing teeth can be replaced by dental implants. However, keeping the gums around the implants healthy is important, as they can be negatively affected by dental plaque and its induced inflammation. Prevention of this may include daily implant cleaning techniques by patients and regular cleaning by dental professionals. Antibacterial mouthrinses may help reduce plaque and bleeding around dental implants, but there is no evidence that powered toothbrushes are better than manual toothbrushes or that brushing with a certain gel or dentifrice is better than another. Among the professionally administered treatments there is no evidence that phosphoric acid is more effective than scaling and polishing, that chlorhexidine enclosed in the inner part of implants is superior to physiologic solution or that a topical antibiotic inserted submucosally is better than a chlorhexidine gel.
[Show abstract][Hide abstract] ABSTRACT: The aim of this controlled randomized clinical trial was to evaluate the efficacy of a xenogeneic collagen matrix (CM) to augment the keratinized tissue around implants supporting prosthetic restorations at 6 months when compared with the standard treatment, the connective tissue autograft, CTG).
This randomized longitudinal parallel controlled clinical trial studied 24 patients with at least one location with minimal keratinized tissue (≤1 mm).
The 6-month width of keratinized tissue. As secondary outcomes the esthetic outlook, the maintenance of peri-implant mucosal health and the patient morbidity were assessed pre-operatively and 1, 3, and 6 months post-operatively.
At 6 months, Group CTG attained a mean width of keratinized tissue of 2.75 (1.5) mm, while the corresponding figure in Group CM was 2.8 (0.4) mm, the inter-group differences not being statistically significant. The surgical procedure in both groups did not alter significantly the mucosal health in the affected abutments. There was a similar esthetic result and significant increase in the vestibular depth in both groups as a result of the surgery. In the CM group it changed from 2.2 (3.3) to 5.1 (2.5) mm at 6 months. The patients treated with the CM referred less pain, needed less pain medication, and the surgical time was shorter, although these differences were not statistically significant when compared with the CTG group.
These results prove that this new CM was as effective and predictable as the CTG for attaining a band of keratinized tissue.
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